Assessment Flashcards
Optimal Nutritional Status
Occurs when there are sufficient nutrients consumed to maintain day-to-day body needs and any increased metabolic demands due to growth, pregnancy, or illness
“Persons having optimal nutritional status are more active, have fewer physical illnesses, and live longer than persons who are malnourished”
Vulnerable Groups and Malnutrition
Infants and children
Pregnant women
Recent immigrants
Persons with low incomes
Homeless persons
Hospitalized persons – increased length of stay, readmit rates, mortality
Aging adults
Frail elderly
Undernutrition
Occurs when nutritional reserves are depleted – when nutrient intake is inadequate to meet day-to-day needs or added metabolic demands
Vulnerable groups are at risk for:
Impaired growth and development
Lowered resistance to infection and disease
Delayed wound healing
Longer hospital stays
Higher health care costs
Overnutrition
Overconsumption of calories, fat & salt; risk for obesity related diseases; DM, CVD
Increases risk for:
Heart disease and hypertension
Type II diabetes
Stroke
Gallbladder disease
Sleep apnea
Certain cancers
Osteoarthritis
Metabolic Syndrome (MetS)
KNOW THIS
Diagnosed in the presence of 3 out of 5 biomarkers – affects 35% of adults and 50% of people age 60 and older
Waist circumference
Gender-based measurements
Glucose level
Above 100 mg/dL or being treated for hyperglycemia
High-density lipoprotein (HDL-C) Gender-based measurements or being treated for hyperlipidemia
Triglyceride (TG) level
Above 150 mg/dL or being treated for elevated TG
Hypertension (HTN)
Systolic and diastolic parameters or being treated for HTN
Fast Facts:
Estimated 17% of children and adolescents, ages 2 to 19 are overweight or obese
66% of adults in United States are either overweight or obese.
For children, overweight defined as body mass index (BMI) equal to or greater than 95th percentile based on age- and gender-specific BMI charts
For adults
Overweight defined as BMI of 25 or greater
Obesity defined as BMI of 30
Being overweight during childhood and adolescence associated with increased risk for becoming overweight during adulthood
BMI Adults
BMI- body mass index
BMI= wt (in lbs.)/ht (in inches)2 x 703
<18.5 underweight
18.5-24.5 normal wt
25-29.9 overweight
30-39.9 obese
>40 extreme overweight
BMI Children
85th percentile - overweight
95th percentile- obesity
Development considerations
Time from birth to 4 months of age is most rapid period of growth in life cycle.
Infants – lose wt. during 1st week of life and then regain, double birth weight by 4 mos. & triple by one year.
Breastfeeding is recommended for full-term infants for first year of life because breast milk is ideally formulated to promote normal infant growth and development and natural immunity.
Breastfeeding may be helpful in avoiding overweight- avoid if mom HIV +
Brain size increases rapidly in early childhood; need for essential fatty acids for development.
Adolescence
Caloric & protein needs increase during adolescence- growth spurts and endocrine and hormonal changes
Caloric and protein requirements increase to meet this demand, and because of bone growth and increasing muscle mass (and, in girls, the onset of menarche), calcium and iron requirements also increase.
Calcium & iron esp. important in girls
Typical girl doubles wt between 8-14; boys between 10-17
Childhood is the most active period in the life span with levels of activity decreasing.
Childbearing
Pregnancy & Lactation
Increased need for calories and protein, vitamins, calcium, iron & other minerals
National Academy of Sciences (NAS) recommends weight gain of
25 to 35 lb for women of normal weight.
28 to 40 lb for underweight women.
11 to 20 lb for overweight women.
Developmental Considerations: Adulthood
Growth and nutrient needs stabilize
Lifestyle factors are a significant contributor to new-onset illness or exacerbation of chronic illness
This is the time to focus on patient education– on how to maintain optimal health (and prevent or delay onset of chronic disease)
Adult emergence of Metabolic syndrome is a concern leading to increased cardiac risk.
lifestyle factors
Smoking, ETOH (alcohol), coffee, lack of exercise, stressful lifestyle, high fat, high salt intake contribute to nutritional deficiencies.
Other considerations
Dental health
Malabsorption
Parasites
Food intolerances
GI diseases
Developmental Considerations: Aging Adult
Age-related changes place older adult at risk for undernutrition or overnutrition
Consider normal physiological changes in aging adults that directly affect nutritional status
Major risk factors include:
Poor physical or mental health
Social isolation
Alcoholism
Limited functional ability
Poverty
Polypharmacy
Physiologic changes of aging
General state of health
Socioeconomic conditions frequently have a significant effect on nutritional status
Decline of extended families and increased mobility of families reduce available support systems
Factors related to meal preparation:
Transportation to grocery stores
Physical limitations
Income
Social isolation
Polypharmacy- multiple medications
Cultural Considerations: Immigrants
Common nutrition-related problems of new immigrants from developing countries include:
General undernutrition
Hypertension
Diarrhea
Lactose intolerance
Osteomalacia (soft bones, vit D deficiency)
Scurvy (vit C deficiency
Dental caries
Cultural Competence and Religion
Knowing a person’s religious practices related to food enables you to suggest improvements or modifications that do not conflict with dietary laws
Kosher
Halal
Islam
Buddhist (vegetarian)
Hindu (vegetarian)
Fasting and other religious observations may limit a person’s food or liquid intake during specified times
Conditions (“allergies”) Affecting Food Options
Lactose intolerance
Lactase enzyme missing or in sufficient amount
Celiac disease
Gluten allergy
Wheat, rye, barley
Autoimmune issue where damage occurs to lining of small intestine
Lactose Intolerance
Present in 30 - 50 million Americans
Up to 80% of African Americans
80% to 100% of Native Americans
90% to 100% of Asian Americans
Least common among people of northern European descent
Nutritional Screening
24-hour recall
Food frequency questionnaire
Food diary
Direct observation of feeding with documentation
For the hospitalized patient, confirm nutritional intake with calorie counts
Consumed and/or infused (TPN)
Expect to monitor I & O
Dietary history and clinical information
Weight and weight history
Physical examination (PE) for clinical signs
Anthropometric measures
Laboratory tests
Subjective Data: Family History
Heart disease
Osteoporosis
Cancer
Gout
Gastrointestinal disorders
Obesity
Diabetes
Cachectic
fat and muscle wasting
Edematous
swollen-extra fluid
Android obesity
Apple Shape
Waist-to-Hip Ratios
Ratio ♂ > 1.0
Ratio ♀ > .8
Gynoid obesity
pear shape
Anthropomorphic Measures
Height
Weight
Triceps skinfold thickness
Waist-to-hip ratio
waist circumference/hip circumference
>1.0 in men
>.8 in women
Indicates high concentration of visceral fat; increased risk for DM,CAD
BMI
Triceps skinfold (TSF)
Standards and techniques are most developed for this site
10% difference from standard suggests under- or over-nutritional state
Mid-arm circumference (MAC)
Estimates skeletal muscle mass and fat stores
Petechiae
Dry/flaky/scaling?
Marasmus
protein-calorie malnutrition – looks starved
Kwashiorkor
protein malnutrition
– may appear well
Pellagra
Niacin deficiency – pigmented scaling lesions
Scorbutic gums
Vitamin C deficiency
Follicular hyperkeratosis
Vitamin A and/or linoleic acid deficiency, dry bumpy skin
Bitot’s spots
Vitamin A deficiency – foamy plaques in cornea
Rickets
Vitamin D and calcium deficiency
Magenta tongue
Riboflavin deficiency – beefy red in appearance
Height issues
Arm span, which correlates with height, may be better measurement for elderly
Best indicators of nutritional status
Glucose
Hemoglobin
Transferrin
Normal hemoglobin level for African Americans is one gram lower than levels for other groups
Data indicate that Native Americans, Hispanics, Asian-Americans, and whites do not differ in this factor
Cholesterol & triglycerides
Serum albumin & total protein
Long term weight loss
Regular physical exercise
4 to 5 times a week for 30 minutes
Eating a low calorie, low fat diet
Caloric intake 1400 to 1500 kcal/day
Fat intake 20% to 25% of total calories
Monitoring daily food intake
Food diary
Portion size
Weight
Nutritional Consequences of Bariatric Surgery
Potential nutritional consequences and related dietary change as a result of surgical intervention.
Malabsorption of protein and calories
-Eat small nutrient dense meals.
Malabsorption of vitamins and minerals
-Taking supplements
Weight regain
-Avoid excess intake of calorically dense/liquid foods.
Obstruction
-Avoid chunks of food that could cause blockage.
Serial assessment
Used to monitor nutritional status in malnourished individuals or in individuals at risk for malnutrition
Evaluate weight and dietary intake weekly in patients who are under-nourished
Because other nutritional assessment indicators may be collected biweekly or monthly
